What happened
On February 28, 2020, an EMBRAER EMB-201A aircraft, registration PT-GYU, operated by CEAL Aviação Agrícola Ltda., was performing agricultural spraying operations in Ivaté, Paraná. Following a period of flight earlier in the day, the aircraft had been repositioned to Querência do Norte, where the pilot utilized the left wing tank to check its functionality and reduce its volume.
Upon returning to the original airfield to resume spraying, the pilot refueled the aircraft but did not perform the condensed checklist. During the takeoff of the third flight of the session, the aircraft experienced a loss of engine power. The pilot was forced to perform an emergency landing in a nearby sugarcane field. The aircraft sustained substantial damage, but the pilot emerged uninjured.
The investigation
CENIPA investigators established that the pilot was fully qualified, holding valid commercial licenses and medical certification, with significant experience in agricultural aviation. The aircraft was within weight and balance limits, and all maintenance records, including the most recent 100-hour inspection, were up to date.
The investigation focused on the fuel management process. The operator had a standard procedure of fueling and using only the right wing tank to prevent errors. However, because the pilot had used the left tank during the earlier repositioning flight, the fuel selector remained set to the left tank. This tank contained only residual fuel, while the right tank held at least 60 liters. The investigation found that the pilot failed to execute the checklist upon resuming operations, which would have prompted a check of the fuel selector.
Findings
- The engine power loss was caused by fuel exhaustion in the active tank.
- The pilot failed to use the checklist when restarting spraying operations.
- The company's standardized procedure of only fueling one tank acted as a failure in the protective barrier, as it did not account for scenarios where the other tank was used.
- The aircraft's "Before Takeoff" checklist did not include a specific requirement to verify the fuel tank selection.
- Factors such as task characteristics, organizational culture, and work organization contributed to the oversight.